Hsu L C
Edwards Lifesciences LLC, Irvine, California, USA.
Perfusion. 2001 Sep;16(5):417-28. doi: 10.1177/026765910101600512.
Heparin-coated circuits have been subjected to vigorous testing, both experimentally and clinically, for the past decade. When the functions of heparin are preserved on the surface, the heparinized surface plays multiple roles in attenuating the systemic inflammatory response. These include the ability to attenuate contact activation, coagulation activation, complement activation and, directly or indirectly, platelet and leukocyte activation. The heparinized surface also renders the cardiopulmonary bypass (CPB) circuits hydrophilic and protein resistant and augments lipoprotein binding. The multifunctional nature of the heparinized surface contributes to the overall biocompatibility of the surface. Clinically, heparin-coated circuits become most effective in reducing systemic inflammatory response and in improving morbidity, mortality, and other patient outcome related parameters when material-independent blood activation is controlled or minimized through a global biocompatibility strategy. Techniques involved in the global biocompatibility strategy are readily available and are being effectively and safely practiced at several centers. With the global biocompatibility strategy, outstanding and reproducible results have been routinely achieved with conventional CPB techniques. Alternative revascularization procedures should equal or surpass conventional CPB, using best clinically proven strategies with respect to patient outcome and long-term graft patency.
在过去十年中，肝素涂层回路已经历了大量的实验和临床测试。当肝素的功能在表面得以保留时，肝素化表面在减轻全身炎症反应方面发挥着多种作用。这些作用包括减弱接触激活、凝血激活、补体激活，以及直接或间接减弱血小板和白细胞激活的能力。肝素化表面还使体外循环（CPB）回路具有亲水性和抗蛋白性，并增强脂蛋白结合。肝素化表面的多功能特性有助于提高表面的整体生物相容性。临床上，当通过整体生物相容性策略控制或最小化与材料无关的血液激活时，肝素涂层回路在减轻全身炎症反应、改善发病率、死亡率和其他与患者预后相关的参数方面最为有效。整体生物相容性策略所涉及的技术很容易获得，并且在多个中心得到了有效且安全的应用。通过整体生物相容性策略，使用传统的CPB技术通常可以取得出色且可重复的结果。替代血管重建程序应等同于或超越传统的CPB，在患者预后和长期移植物通畅方面采用临床上已证实的最佳策略。
